System and method for controlling a transverse phacoemulsification system with a footpedal

ABSTRACT

A method and system for controlling an ultrasonically driven handpiece employable in an ocular surgical procedure is provided. The method includes operating the ultrasonically driven handpiece in a first tip displacement mode, such as a longitudinal mode according to a first set of operational parameters, and enabling a user to alter the ultrasonically driven handpiece to employ a second tip displacement mode, such as a transversal or torsional mode, using a second set of operational parameters. Enabling the user to alter performance of the handpiece comprises the user being enabled to dynamically select operational parameters for the first tip displacement mode relative to the second tip displacement mode by using, for example, a switching apparatus such as a footpedal.

This application is a continuation-in-part of co-pending U.S. patentapplication Ser. No. 11/753,554, entitled “Systems and Method forTransverse Phacoemulsification,” filed May 24, 2007, inventors Mark E.Steen, et al., the entirety of which is incorporated herein byreference.

BACKGROUND OF THE INVENTION Field of the Invention

The present invention relates generally to the art of ocular surgery,and more specifically to controlling a phacoemulsification surgicalinstrument system during ophthalmic procedures.

Description of the Related Art

Today's ocular surgery, such as phacoemulsification surgery, can involvemedical instrument systems that provide for handpiece operation in atraditional longitudinal ‘cutting’ mode. Longitudinal cutting occurs bycontrolling movement of the phaco tip forward and backward along asingle axis. Longitudinal cutting represents the foundation for manyhandpiece modes. Newer technology affords surgeons the choice oftorsional or transversal cutting actions in the form of handpieceoperational modes, in addition to traditional longitudinal tip action.

Traditional longitudinal cutting operation is effective at boring intothe cataract, but can present issues with removing lenticular matter asthe particle tends to be repelled from the tip. Torsional andtransversal methods can offer improved surgical performance undercertain conditions, but it is difficult for the tip found in torsionaland transversal designs to bore into the particle. The inability of thetip to effectively cut the particle limits these designs when comparedto traditional designs, thus potentially reducing the surgeon's overallcutting efficiency.

Today's state of instrument system design provides for switching betweentorsional and traditional, transversal and traditional, onlytransversal, only torsional, and only traditional (longitudinal)operation. During surgery, surgeons currently choose between handpieceoperation modes to improve the efficacy of the surgical procedure,including reducing the amount of heat introduced into the patient's eye.Multiple mode operation available in today's instrument designsincreases the medical instrument's operational flexibility whileconducting the surgical procedure and helps surgeons perform the mosteffective, efficient and safest possible surgery. Combining cuttingtechnologies can make phacoemulsification safer and maximizes surgicalbenefit by avoiding complications such as chatter while improvingprocedure efficiency, minimizing the incision size, and reducing theamount of heat introduced into the patient's eye. Currently, switchingbetween modes, such as between longitudinal, torsional, and transversalmodes simply entails the surgeon selecting a combination of modes priorto the surgical procedure.

Certain available instrument system designs having torsional ortransversal technology operate using a uniform ratio of longitudinal tipdisplacement in relation to transversal or torsional tip displacement.Designs that afford interleaving of longitudinal and transversal tipdisplacement, where depressing the footpedal device causes theinstrument to switch back and forth between the two cutting modes, donot allow the surgeon to vary or change the amount of time that a moderemains in effect regardless of amount of footpedal depression norelapsed time footpedal is depressed. In short, the options for usingmodes are limited to switching between modes using the user interface ora switch such as the footpedal, and are therefore limited.

Based on the foregoing, it would be advantageous to provide for a systemand method that enables a surgeon to quickly and accurately vary thesurgical instrument transversal tip motions for use in controllingmedical instrument systems that overcomes the foregoing drawbackspresent in previously known designs.

SUMMARY OF THE INVENTION

According to one aspect of the present design, there is provided amethod for controlling an ultrasonically driven handpiece employable inan ocular surgical procedure. The method includes operating theultrasonically driven handpiece in a first tip displacement mode, suchas a longitudinal mode, according to a first set of operationalparameters, and enabling a user to alter the ultrasonically drivenhandpiece to employ a second tip displacement mode, such as anon-longitudinal motion, for example a transversal or torsional mode,using a second set of operational parameters. Enabling the user to alterthe handpiece comprises the user being enabled to dynamically selectoperational parameters for the first tip displacement mode relative tothe second tip displacement mode.

According to a second aspect of the present design, there is provided anapparatus configured for use in a surgical instrument device employablein an ocular surgical procedure. The apparatus includes a handpiecehaving an ultrasonically vibrating tip supporting a plurality ofoperating modes including a first operating mode, an engageableswitching apparatus, and a controller connected to the handpiece andengageable switching apparatus. The controller is configured to receivedata from the engageable switching apparatus and adjust at least oneparameter associated with the first operating mode and relatively adjustat least one parameter associated with a second operating mode based onthe data received from the engageable switching apparatus.

These and other advantages of the present invention will become apparentto those skilled in the art from the following detailed description ofthe invention and the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In order to better appreciate how the above-recited and other advantagesand objects of the inventions are obtained, a more particulardescription of the embodiments briefly described above will be renderedby reference to specific embodiments thereof, which are illustrated inthe accompanying drawings. It should be noted that the components in thefigures are not necessarily to scale, emphasis instead being placed uponillustrating the principles of the invention. Moreover, in the figures,like reference numerals designate corresponding parts throughout thedifferent views. However, like parts do not always have like referencenumerals. Moreover, all illustrations are intended to convey concepts,where relative sizes, shapes and other detailed attributes may beillustrated schematically rather than literally or precisely.

FIG. 1 is a diagram of a phacoemulsification system known in the art;

FIG. 2 is another diagram of a phacoemulsification system known in theart;

FIG. 3 is a diagram of a phacoemulsification handpiece known in the art;

FIGS. 4a, 4b, 4c, 4d and 4e are drawings of phacoemulsification needlesin accordance with the present design;

FIGS. 5a and 5b are drawings of phacoemulsification needles;

FIG. 6 is a drawing of a phacoemulsification needle;

FIG. 7 is a plot of the 90-degree phase shift between the sine waverepresentation of the voltage applied to a piezoelectricphacoemulsification handpiece and the resultant current into thehandpiece;

FIG. 8a is a plot of the phase relationship and the impedance of apiezoelectric phacoemulsification handpiece;

FIG. 8b is a plot of the range of transverse motion with respect tofrequency;

FIGS. 9a and 9b are drawings of phacoemulsification foot pedals;

FIGS. 10a, 10b, and 10c are drawings of phacoemulsification horns;

FIG. 10d is a plot of the phase relationship and the impedance of apiezoelectric phacoemulsification handpiece;

FIG. 11 is a drawing of a phacoemulsification horn;

FIG. 12 is a drawing of a phacoemulsification horn;

FIG. 13 is a drawing of a phacoemulsification horn;

FIG. 14A illustrates the duty cycle from previous designs wherein thepower delivery for longitudinal and transversal cutting modes ispermanently fixed in time;

FIGS. 14B and 14C illustrate the duty cycles wherein the power deliveryfor longitudinal and transversal or torsional cutting modes isadjustable by the surgeon;

FIG. 15A illustrates the present design's footpedal position 1510 as apercentage of maximum footpedal displacement for longitudinal cuttingmode A;

FIG. 15B shows the conceptual working components for a footpedal inaccordance with an aspect of the present invention;

FIG. 16 is a first graph showing vacuum pressure relative to varioussystem settings; and

FIG. 17 is a second graph showing vacuum pressure relative to varioussystem settings.

DETAILED DESCRIPTION OF THE INVENTION

A number of medically recognized techniques are utilized for cataracticlens removal based on, for example, phacoemulsification, mechanicalcutting or destruction, laser treatments, water jet treatments, and soon.

The phacoemulsification method includes emulsifying, or liquefying, thecataractic lens with an ultrasonically driven needle before the lens isaspirated. A phacoemulsification system 5 known in the art is shown inFIG. 1. The system 5 generally includes a phacoemulsification handpiece10 coupled to an irrigation source 30 and an aspiration pump 40. Thehandpiece 10 includes a distal tip 15 (shown within the anterior chamberof the patient's eye 1) that emits ultrasonic energy to emulsify thecataractic lens within the patient's eye 1. The handpiece 10 furtherincludes an irrigation port 25 proximal to the distal tip 15, which iscoupled to an irrigation source 30 via an irrigation line 35, and anaspiration port 20 at the distal tip 15, which is coupled to anaspiration pump 40 via an aspiration line 45. Concomitantly with theemulsification, fluid from the irrigation source 30, which is typicallyan elevated bottle of saline solution, is irrigated into the eye 1 viathe irrigation line 35 and the irrigation port 25, and the irrigationfluid and emulsified cataractic lens material are aspirated from the eye1 by the aspiration pump 40 via the aspiration port 20 and theaspiration line 45.

Turning to FIG. 2, a functional block diagram of a phacoemulsificationsystem 100 known in the art is shown. The system 100 includes a controlunit 102 and a handpiece 104 operably coupled together. The control unit102 generally controls the operating parameters of the handpiece 104,e.g., the rate of aspiration A, rate of irrigation (or flow) F, andpower P applied to the needle, and hence the eye E. The control unit 102generally includes a microprocessor computer 110 which is operablyconnected to and controls the various other elements of the system 100.The control unit 102 may include an aspiration pump, such as a venturi(or vacuum-based pump) or a variable speed pump 112 (or a flow based orperistaltic pump) for providing a vacuum/aspiration source, which, inthe case of a variable speed pump 112, can be controlled by a pump speedcontroller 116. The unit 102 further includes an ultrasonic power source114 and an ultrasonic power level controller 118 for controlling thepower P applied to the needle of the handpiece 104. A vacuum sensor 120provides an input to the computer 110 representing the vacuum level onthe output side of the pump 112. Venting may be provided by a vent 122.The system 100 may also include a phase detector 124 for providing aninput to the computer 100 that represents the phase between a sine waverepresentation of the voltage applied to the handpiece 104 and theresultant current into the handpiece 104. Further disclosure about thephase detector 124 can be found in U.S. Pat. No. 7,169,123 toKadziauskas et al., which is incorporated herein in its entirety byreference. The functional representation of the system 100 also includesa system bus 126 to enable the various elements to be operably incommunication with each other.

Turning to FIG. 3, the cross-section along the longitudinal axis of aportion of a phacoemulsification handpiece 200 known in the art isshown. Generally, the handpiece 200 includes a needle 210, defining alumen that is operatively coupled to the aspiration pump 40 (FIG. 1),forming an aspiration line 214. The proximal end of the needle 210 iscoupled to a horn 250, which has its proximal end coupled to a set ofpiezoelectric crystals 280, shown as three rings. The horn 250, crystals280, and a proximal portion of the needle 210 are enclosed within ahandpiece casing 270 having an irrigation port coupled to an irrigationline 290 defining an irrigation pathway 295. The irrigation line 290 iscoupled to the irrigation source 30 (FIG. 1). The horn 250 is typicallyan integrated metal, such as titanium, structure and often includes arubber 0 ring 260 around the mid-section, just before the horn 250tapers to fit with the needle 210 at the horn's 250 distal end. The 0ring 260 snugly fits between the horn 250 and the casing 270. The 0 ring260 seals the proximal portion of the horn 250 from the irrigationpathway 295. Thus, there is a channel of air defined between the horn250 and the casing 270. Descriptions of handpieces known in the art areprovided in U.S. Pat. No. 6,852,092 (to Kadziauskas et al.) and U.S.Pat. No. 5,843,109 (to Mehta et al.), which are hereby incorporated byreference in their entirety.

In preparation for operation, a sleeve 220 is typically added to thedistal end of the handpiece 200, covering the proximal portion of theneedle 210 (thus, exposing the distal tip of the needle), and the distalend of the irrigation pathway 295, thereby extending the pathway 295 anddefining an irrigation port 222 just before the distal tip of the needle210. The needle 210 and a portion of the sleeve 220 are then insertedthrough the cornea of the eye to reach the cataractic lens.

During operation, the irrigation path 295, the eye's chamber and theaspiration line 214 form a fluidic circuit, where irrigation fluidenters the eye's chamber via the irrigation path 295, and is thenaspirated through the aspiration line 214 along with other materialsthat the surgeon desires to aspirate out, such as the cataractic lens.If, however, the materials, such as the cararactic lens, are too hardand massive to be aspirated through the aspiration line 214, then thedistal end of the needle 210 is ultrasonically vibrated and applied tothe material to be emulsified into a size and state that can besuccessfully aspirated.

The needle 210 is ultrasonically vibrated by applying electric power tothe piezoelectric crystals 280, which in turn, cause the horn 250 toultrasonically vibrate, which in turn, ultrasonically vibrates theneedle 210. The electric power is defined by a number of parameters,such as signal frequency and amplitude, and if the power is applied inpulses, then the parameters can further include pulse width, shape,size, duty cycle, amplitude, and so on. These parameters are controlledby the control unit 102 and example control of these parameters isdescribed in U.S. Pat. No. 7,169,123 to Kadziauskas et al.

In a traditional phacoemulsification system 100, the applied electricpower has a signal frequency that causes the crystal 280, horn 250, andneedle 210 assembly to vibrate at a mechanically resonant frequency.This causes the needle 210 to vibrate in the longitudinal direction witha maximum range of motion, which many consider to be the state where theneedle's cutting efficacy is at its maximum. However, there are a coupleof known drawbacks. First, at this frequency, maximum power is appliedto the needle that results in maximum heat introduced into the eye,which can cause undesirable burning of eye tissue. Second, thelongitudinal motion can cause the material being emulsified to repelaway from the needle, which is undesirable when the goal is to keep thematerial close to the needle to be aspirated (a quality often referredto as the needle's or handpiece's “followability”).

Non-longitudinal operating modes currently include torsional andtransversal modes. Torsional phacoemuisification designs involveoperating the cutting tip in a rotational manner. The torsional modeproduces a shearing action at the phaco tip and can be useful inbreaking up the nucleus of the cataract. The resulting shearing action,when compared with longitudinal chiseling actions resulting fromcyclical bursts, can reduce tae amount of repulsion of nuclear materialexperienced at the phaco handpiece tip. In this way, torsional designsor modes may efficiently operate in an occluded or semi-occluded stateby maintining the position of icular material on or at the phacohandpiece tip during surgery.

Transversal or transverse ultrasound phacoemulsifcation technologyenables operation of the cutting blade with traditional forward-and-backlongitudinal stroke action in combination with side-to-side transversalmovements. The tip motion realized from combining these two operatingmodes produces a cutting motion that. follows an elliptical pattern atthe phaco handpiece tip. The transversal mode integrates the forwardcutting motion found in longitudinal designs with the shearing action intorsional designs at the phaco handpiece tip. Transversal operation modecan reduce the amount of ‘chatter’ resulting from the lens particletargeted for removal bouncing off of the phaco tip.

To address the heat issue, the power can be applied in pulses, wherelittle or no power is applied in between the pulses, thus reducing thetotal amount of power and heat applied to the needle 210. To address thefollowability issue, the power can be applied to the handpiece 200 tocause the needle 210 to vibrate in the transverse direction. An exampleof this approach is described in U.S. patent application Ser. No.10/916,675 to Boukhny (U.S. Pub. No. 2006/0036180), which describescausing the needle 210 to vibrate in a torsional or twisting motion,which is a type of transverse motion. This Boukhny application describesapplying to the power to the needle 210 with a signal that alternatesbetween two frequencies, one that causes longitudinal motion, and onethat causes torsional motion with a particular type of horn havingdiagonal slits. This solution does provide for followability, butcutting efficacy leaves much for improvement.

Referring to FIG. 3, there are existing phacoemulsification systems thatenable the distal end of the phaco needle 210 to ultrasonically vibratein a direction of the longitudinal axis of the handpiece 200, i.e., inthe z direction, which provides optimum cutting efficacy but may causeless than optimum followability. There are also systems that enable thedistal end of the phaco needle 210 to ultrasonically vibrate in adirection that is transverse of the longitudinal axis of the handpiece200, in the x and/or y direction, which provides followability but lessthan optimum cutting efficacy. There further are systems that enable thedistal end of the needle 210 to alternate between one type of directionand another by alternating between two different pulses of energyapplied to the handpiece 200, each pulse having different signalfrequencies. However, it may be desirable to enable the distal end ofthe needle 210 to move in both the transverse (x and/or y) andlongitudinal (z) within a single pulse of energy or from power appliedto the handpiece 200 having a single effective operating frequency,i.e., a frequency that may slightly shift due to conditions such astuning, e.g., an effective operating frequency of 38 kHz may shift+or−500 Hz. A phacoemulsification system 100 that can achieve this gainsthe benefit of both followability and cutting efficacy.

There are two aspects of a phacoemulsification system that canindividually or collectively enable both transverse and longitudinalultrasonic vibration, (1) the structure of the handpiece 200 includingthe needle 210 and the horn 250, and (2) the computer readableinstructions within the control unit 102. With regard to the structureof the handpiece 200, there are two aspects to the structure that canindividually or collectively facilitate the desired outcome. First isthe handpiece 200 center of mass relative to its longitudinal axis, andsecond is the structure of the handpiece 200 at the nodes and anti-nodesof the handpiece 200.

Turning to FIG. 4a , a needle 1000 is shown in accordance with apreferred embodiment of the invention. The needle 1000 is configured tobe coupled to the distal end of an ultrasonically vibrated horn, e.g.,250. The needle 1000 includes a distal tip 1010 defining a lumen 1005for aspiration, a needle base 1020 proximal to the tip 1010, and aneedle interface/adapter 1030 to couple the needle with the horn, e.g.,250. Conventional needles, e.g., 210, have a center of mass located onits longitudinal axis. The needle 1000 has a structure with a center ofmass that is off from the longitudinal axis. This is achieved by havingan asymmetric needle base 1020.

Turning to FIG. 4b , a cross-sectional view of the needle 1000 is shownfrom the direction i, as indicated in FIG. 4a . The needle base 1020 hasa portion of mass etched out, leaving a portion 1027, creating anasymmetric configuration. Alternative needle base configurations 1035,1045, and 1055 are shown in FIGS. 4c, 4d, and 4e respectively. FIG. 4eshowing an asymmetric needle base 1055 having a single sidesubstantially carved out or flattened.

Turning to FIG. 5a , another needle 2000, having a distal tip 2010, base2020, and needle interface/adapter 2030, is shown with a center of massoff from the longitudinal axis. In the alternative, or in addition to,the asymmetric base 1020, the needle 2000 can have an off-centerinterface/adapter 2030. Turning to FIG. 5b , a cross-sectional view ofthe needle 200 is shown from the direction ii, as indicated in FIG. 5a .The interface/adapter 2030 is concentric with but off-center with theaspiration line 2005.

Turning to FIG. 6, another needle 3000, having a distal tip 3010, base3020, and needle interface/adapter 3030, is shown with a center of massoff from the longitudinal axis. In addition to, or in the alternative,to the embodiments described above, though the outside surface 3015 ofthe needle 3000 is parallel with the longitudinal axis, the aspirationline 3005 is configured to be angled with respect to the needle's 3000longitudinal axis.

As mentioned above, the control unit 102 can also contribute toproviding transverse and longitudinal motion of the needle, e.g., 210,1000, 2000, and 3000. The typical range of frequencies used for aphacoemulsification system 100 is between about 20 kHz and about 60 kHz.The frequency used often depends upon the structure of the handpiece 200and many systems 100 are designed to apply a frequency corresponding tothe resonant frequency of the handpiece 200, which, as explained above,causes the needle 210 to vibrate in a maximum longitudinal range ofmotion. When the frequency applied to the handpiece is significantlyhigher, or lower than resonancy, it responds electrically as acapacitor. The representation of this dynamic state is shown in FIG. 7in which curve 60 (solid line) represents a sine wave corresponding tohandpiece 30 current and curve 62 (broken line) represents a sine wavecorresponding to handpiece 30 voltage.

Turning to FIG. 8, as is known in the art, the impedance of the typicalphacoemulsification handpiece 200 varies with frequency, i.e., it isreactive. The dependence of typical handpiece 30 phase and impedance asa function of frequency is shown in FIG. 8a in which curve 64 representsthe phase difference between current and voltage of the handpiecesfunction frequency and curve 66 shows the change in impedance of thehandpiece as a function of frequency. The impedance exhibits a low at“Fr” and a high “Fa” for a typical range of frequencies.

Some conventional phacoemulsification systems 100 apply power to thehandpiece 200 at Fr (point A) which generally causes the needle 210 tovibrate in the longitudinal direction. In one approach, particularlywith the needles described above, 1000, 2000, and 3000, it may bedesirable to move the signal frequency of the power applied to thehandpiece 200 up to point C. The frequency applied at point C causes theneedle, e.g., 210, 1000, 2000, and 3000, to effectively vibrate both inthe z direction as well as the x and/or y direction (i.e., sustained andsubstantial vibration as opposed to transitional vibration, such asvibration that could occur when the power signal shifts from onefrequency causing longitudinal movement to a second frequency causingtransversal movement, or incidental vibration, such as any minimaltransversal vibration when the needle is predominantly vibrating in thelongitudinal direction). It was determined that the ratio of range ofmotion between the longitudinal and the transverse direction isapproximately 1:1 with about 0.75 to 1 mil range of motion in bothdirections, which provides the operation of the needle with effectivefollowability and cutting efficacy. However, power usage at thisfrequency is less than a Watt, so the longitudinal range of motion iseffective but limited, and thus, so is the cutting efficacy. To increasethe cutting efficacy, the impedance can be increased, which can beachieved by moving the operating frequency down to point B, where thelongitudinal range of motion increases, thereby increasing cuttingefficacy. Turning to FIG. 8b , the amount of transverse motion isgraphed relative to the frequency from point C to point B. This showsthat the range of transverse motion increases as the frequency decreasesup to a certain point before reaching point B, and then the transversemotion range saturates at a point between point B and point C, C′. Forthe standard WhiteStar™ handpiece, the Fr is approximately 36.6 kHz, Fais approximately 37.1 kHz, point B is approximately 37.2 kHz, and pointC is approximately 37.8 kHz.

A surgeon can control these various types of vibrations by using afootswitch that is coupled with the control unit 102. With reference toFIG. 9a , there is shown apparatus 80 for controlling a handpiece 200during surgery which includes a foot pedal 12 pivotally mounted to abase 14 for enabling a depression thereof in order to provide controlsignals for handpiece 200 operation. A foot pedal 12 may be similar oridentical to known foot pedals such as, for example set forth in U.S.Pat. No. 5,983,749, issued Nov. 16, 1999 for Dual Position Foot Pedalfor Ophthalmic Surgery apparatus or U.S. patent application Ser. No.09/140,874 filed Aug. 29, 1998, for “Back Flip Medical Foot Pedal”.

Support surfaces in the form of shrouds 29, 22 may be provided anddisposed adjacently foot pedal 12 on opposite sides 26, 31 at a positionenabling access thereto by a user's foot (not shown). The first andsecond foot activated ribbons switches 34, 36 to are disposed on thesurfaces 29, 22 in a conventional manner, and have a length extendingalong the surfaces 29, 22 sufficient to enable actuation of the ribbonswitches 34, 36 by a user's foot (not shown) without visual operationthereof by the user (not shown). More detail about this footswitch 80can be found in U.S. Pat. No. 6,452,123 to Chen, which is herebyincorporated in its entirety.

As can be appreciated by one of ordinary skill in the art, thefootswitch 80 can be configured to control the longitudinal vibration ofthe distal end of the needle 210, 1000, 2000, and 3000 with the pitchmovement of the footpedal 52 via the control unit 102 by associating thepitch movement of the foot pedal 12 with the power level and transversevibration of the distal end of the needle 210, 1000, 2000, and 3000 witheither ribbon switches 36, 36 or vice versa.

Turning to FIG. 9b , another footswitch 26 in accordance with apreferred embodiment is shown. The footswitch 26 includes a base 48, twoside switches 56, a data and/or power cable 28 to couple the footswitch26 to the control unit 102 (a wireless interface known in the art, suchas Bluetooth, can also be employed), and a footpedal 52 that allows forboth pitch and yaw movement. As can be appreciated by one of ordinaryskill in the art, the footswitch 26 can be configured to control thelongitudinal vibration of the distal end of the needle 210, 1000, 2000,and 3000 with the pitch movement of the footpedal 52 via the controlunit 102 by associating the pitch movement of the footpedal 52 with thelongitudinal power level and transverse vibration of the distal end ofthe needle 210, 1000, 2000, and 3000 with either the yaw movement of thefootpedal 52 or the side switches 56. For example, the yaw movement ofthe footpedal 52 or the side switches 56 can be associated with thefrequency of the power applied to the handpiece 200. In a furtherexample, the yaw movement of the footpedal 52 can be associated with therange of frequencies between point B and point C in FIG. 8b . Inaddition, the side switches 56 can be used to allow the surgeon totoggle between using point A, where cutting efficacy is at its optimum,and using a frequency between point B and point C, where transversemotion can be controlled by the yaw movement of the footpedal 52.

In addition to, or in the alternative to, the needle structure, e.g.,210, 1000, 2000, and 3000, transverse and simultaneoustransverse/longtiduinal vibrations can further be achieved through thestructure of the horn 250 and piezocrystal stack 280 configuration.Generally, it may be desirable to configure the horn 250 to have anasymmetric mass or a center of mass off from the horn's 250 longitudinalaxis. Turning to FIG. 10a , a horn 4000 in accordance with a preferredembodiment is shown. The horn 4000 includes a distal end 4010,configured to engage an ultrasonic needle, e.g., 210, 1000, 2000, and3000. The distal end 4010 of the horn 4000 has a diameter ofapproximately 0.146″. The horn 4000 defines a lumen 4015, whichfunctions as an aspiration line. The proximal section of the horn 4000,which has a diameter of about 0.375″, includes a notch 4020 having alength of approximately 0.1875″ and a core width of approximately0.155″. The distance between the distal end 4010 of the horn 4000 andthe distal end of the notch 4020 is approximately 1.635″. The proximalsection of the horn 4000 is coupled to a stack of piezoelectric crystalrings 4030.

In FIG. 10b , a cross-section of the horn 4000 taken along directionline iii is shown. In one embodiment, the notch 4020 is created bycarving out three sides of the horn 4000 at the location of the notch4020. In another embodiment, shown in FIG. 10c , a horn 4100 is shownwith a notch defined by only one side. Multiple notches can be created.

A profile of this horn's 4000 characteristics along a frequency spectrumis shown in FIG. 10 d.

Phacoemulsification handpieces 200 typically have multiple resonantfrequencies. The impedance/phase profile shown in FIG. 8b is for thetraditional operating frequency, e.g., in the range of 30 to 40 kHz. Asimilar profile can also be shown at other resonant frequencies, e.g.,in the range of 20 to 30 kHz as well as between 55 and 65 kHz. With horn4000, it was determined that at 38 kHz, a maximum range of longitudinalvibration is provided at the needle 210 distal tip. When the operatingfrequency, however, is dropped down to a lower resonant frequency, e.g.,26 kHz, both effective (sustained and substantial) transverse andeffective longitudinal ranges of motion are provided at the needle 210distal tip. Furthermore, depending on the shape and location of thenotch 4020 formed on the horn 4000, an additional transversal node canbe created on the frequency spectrum, e.g., point D (which wasdetermined to be about 28 kHz with horn 4000, where the operatingfrequency at point D causes the needle 210 distal tip to vibratepredominantly in the transverse direction, e.g., x and/or y direction.The location of the transversal node, point D, relative to the resonantfrequencies, is dependent upon the horn configuration and material, andcan even be used to coincide with a resonant frequency, therebyenhancing transversal motion at that frequency.

The following are other horn configurations that can provide the profilediscussed above and shown in FIG. 10c . In FIG. 11, another horn 4500configuration is shown having a notch 4510, wherein the notch 4510 isfilled with an acoustic material known in the art, such as silicon.Turning to FIG. 12, another horn assembly 5500 is shown having the hornbody 5560 and piezocrystal crystal stack 5570 define a lumen 5550 thatis off from the horn's 5500 central longitudinal axis. In FIG. 13,another horn assembly 5700 is shown having the piezocrystal stacks 5710with staggered slightly.

Accordingly, with a phacoemulsification handpiece 200 constructed with ahorn 4000, 4500, 5500, 5700, the control unit 102 can be configured toprovide three types of vibration for the ultrasonic needle, 210, 1000,2000, or 3000, (1) longitudinal, (2) transversal, and (3) a hybrid witheffective transversal and effective longitudinal motion. Furthermore,the control unit 102 can also apply variations of these modes in pulses,as described in U.S. Pat. No. 7,169,123, wherein a single pulse ofenergy with a single operating frequency applied to the needle can causedistal end of the needle 210, 1000, 2000 or 3000 to vibrate in eitherthe longitudinal direction, transversal direction, or both, and furtherwherein different pulses causing different types of vibration can bejuxtaposed and controlled by the surgeon, such as by the interfacedevice 140, which may be a computer or the footswitch 26, 80, andfurther wherein operating multiple frequencies simultaneously giveshybrid motion. The pulses described above can further be shaped, asdescribed in U.S. patent application Ser. No. 10/387,335 to Kadziauskaset al., which is hereby incorporated by reference in its entirety.

Footpedal Control of Ultrasonic Operation

The present design provides an ability to specifically controllongitudinal transversal motions of the handpiece tip during ophthalmicprocedures with a phacoemulsification surgical instrument using detectedswitch/footpedal position, beyond mere switching between the modes. Thepresent design drives the handpiece tip from a footpedal duringtransversal mode operation by varying the ratio of longitudinal andtransversal tip displacements in relation to the amount the surgeon oruser depresses the footpedal.

As used herein, the term “switching apparatus,” “switching device,”“engageable switching apparatus,” “switch,” or similar terminology, isintended to broadly mean any device, hardware, software, orfunctionality that facilitates or enables changing or modulating betweenone parameter and another. Thus as used herein, these terms may includebut are not limited to an actual physical switch, such as may be offeredon the phaco instrument or handpiece or elsewhere in the operatingtheater, a user interface or computing device configured to operate as aswitch via software, a footpedal or similar device, or any other deviceor arrangement configured to perform the aforementioned switchingfunctionality.

Switching in the present design may be from longitudinal tonon-longitudinal modes, such as transversal and/or torsional, switchingfrom non-longitudinal modes to longitudinal mode, switching withinmodes, such as from one frequency of transversal operation to anotherfrequency of transversal operation, or switching one mode while anothermode is operating, such as a combined or superimposed longitudinal andnon-longitudinal motion where switching increases frequency oflongitudinal operation while decreasing frequency of non-longitudinaloperation, or vice versa. Switching may occur based on achievingthresholds, operating within ranges, or based on nonlinear,unconventional, or combined factors or statistics.

The handpiece driving arrangement involves an interleaving oflongitudinal tip displacement combined with transversal tip displacementin a control signal from the instrument system for directing thehandpiece tip transversal cutting motions. Based on footpedal movement,the system adjusts the tip displacement control signal to vary thecutting mode tip displacement ratio based on footpedal deflection whilethe instrument switches back and forth between the two different cuttingmodes. The cutting mode tip displacement ratio can be likened to a ‘dutycycle’ representing the amount of time allocated to each cutting mode,where more deflection of the footpedal results in a higher percentage ofone mode, such as longitudinal, and a lower percentage of another mode,such as transversal.

The present design enables superimposing of control signals rather thandiscrete times when each mode is operating. For example, thelongitudinal mode may be operating and may combine with the transversalmode, where longitudinal operation is at a first frequency andtransversal mode operating at a second frequency, different from or thesame as the first frequency. Alternately, parameters for a single tipdisplacement mode may be relatively interleaved or superimposed, such asfrequency and power in transversal operation. In an arrangement wherelongitudinal mode is combined with transversal mode, the user mayrequest longitudinal mode operating at 38 kHz and transversal modeoperating at 26 khz, where both modes operate simultaneously. Thesefrequencies are examples only, and the frequencies may be higher orlower depending on circumstances.

FIG. 14A illustrates the duty cycle of a design wherein power deliveryfor longitudinal and transversal cutting modes is permanently fixed at aconstant, even 50%/50% division in time 1450. FIGS. 14B and 14Cillustrate examples of a variable duty cycle for controlling handpiecetip motions, i.e. ultrasonic blade movements. Compared with previousdesign mode timing diagrams such as illustrated in FIG. 14A, FIG. 14Billustrates the variable duty cycle mechanism configured to operate at20% duration assigned to longitudinal mode A at 1410 and 80% durationfor the transversal cutting mode B at 1420 to control cutting motions atthe handpiece tip when operated in a transversal ultrasonic mode. Inorder to select the 20%/80% duty cycle presented in FIG. 14B, thesurgeon engages a switch such as by depressing the footpedalapproximately one fourth of the total pedal travel to operate theinstrument system power delivered to the handpiece for each cuttingmode.

FIG. 14C illustrates the variable duty cycle mechanism set to operate at40% duration assigned to longitudinal mode A at 1430 and 60% transversalcutting mode B at 1440 to control power delivery at the handpiece tipfor each longitudinal and transversal cutting tip displacement,respectively.

For example, in one embodiment the present designs arrangement mayenable the surgeon to choose an instrument setting via a graphical userinterface or other input device, seeking to increase the amount oflongitudinal motion or power as the footpedal is depressed. In thisexample, the instrument system may increase or decrease the amount oflongitudinal power delivered to the handpiece tip during an ocularprocedure in real-time in accordance with the footpedal positiondetermined by the surgeon.

Note that in the foregoing example, the concept of duty cycle andrelative power applied may be time based or power based, in that a 60/40split represents, for example, 60 per cent of the time in mode A and 40per cent of the time in mode B, which may be interleaved or in groups.As an example, when the footpedal indicates 60 per cent mode A and 40per cent mode B, three mode A pulses may exist interleaved by two mode Bpulses, or alternately, 60 mode A pulses may occur before four mode Bpulses, or some other desired combination of pulses. Alternately, thepower or speed of the individual modes may be increased, where 60 percent power is available for mode A and 40 per cent for mode B, with astrict time interleaving. In this example, half the time may be spent inmode A and half spent in mode B, but mode A uses more power, i.e. drivesthe needle at a 60 per cent power level, while mode B is driven at a 40per cent power level. Other hybrid combinations of tip or needleoperation may be realized using the present design. Parameters beyondtime and power may be controllable by a device such as a footpedal,including but not limited to frequency.

Thus in the present design, the apparatus may relate footpedal positionto percent of maximum power supplied at the handpiece using theinstrument system illustrated in FIG. 15A. FIG. 15A illustratesfootpedal position 1510, i.e. the amount of pedal depression or movementrelative to the total pedal movement, i.e. a percentage of maximumfootpedal displacement 1501 for longitudinal cutting mode A. For eachpercentage of maximum footpedal displacement 1501, the present designmay change the amount of power, on-time, or duty cycle allocated to onefrequency between the two cutting tip movements for longitudinal timeduration 1502 and transversal time duration 1503.

FIG. 15B diagrammatically shows the conceptual working components forfootpedal 1520, which includes pedal 1521 and base 1522. The footpedal1520 may be configured as illustrated in FIG. 15B, and the instrumentsystem can vary the duty cycle for controlling the handpiece cuttingmotions while operating in the transversal phacoemulsification mode.

In another embodiment, the handpiece driving arrangement control signalmay include a longitudinal component with a transversal component foreach method of driving the tip cutting motion displacements. In thisarrangement, the configuration may combine two frequencies, where onefrequency is assigned to control the amount of longitudinal displacementand the second frequency is assigned to control the amount oftransversal displacement. In this arrangement, the present design mayvary the amount of each frequency relative to footpedal depression. Forexample, as the surgeon depresses the footpedal, the instrument mayincrease the amount of power or frequency of power delivered forlongitudinal operation while concurrently decreasing the power orfrequency delivered for transversal operation. In this manner, thepresent design may vary or change the ratio of longitudinal totransversal tip displacement.

In short, the apparatus may provide for real-time control of the medicalinstrument system and enable dynamic alterations to the duty cycle orratio that indicates the amount of time the handpiece tip operates inthe longitudinal versus the transversal cutting mode. During the courseof the surgical procedure, the surgeon may change the duty cycle inresponse to observed surgical events. For example, if the surgeondetermines the handpiece tip is not effectively boring into thelenticular matter, such as a lens particle, the surgeon may select adifferent duty cycle ratio favoring a longer longitudinal duration.

While certain operational parameters in the ultrasonic handpieceembodiment may be controlled using the present design, it is to beunderstood that those parameters controllable can include but are notlimited to power, aspiration, frequency, vacuum, and so forth,controllable by user input in a device such as a footpedal or via aswitch on the handpiece or some other implementation.

The present design is intended to provide a reliable, noninvasive, andefficient automatic control mechanism for a medical instrument systemthat can be readily altered. The present design may be used todynamically control the phacoemulsification surgical instrument systemin real-time while operating in a transversal cutting operational mode.

Automatic Longitudinal/Transversal Ultrasonic Operation Based On SensedValues

The present design controls the handpiece tip during ophthalmicprocedures based on detected or sensed values, such as vacuum, reportedfrom an instrument sensor. An example of detecting vacuum reported froma sensor is illustrated in FIG. 1. In FIG. 1, phacoemulsification system100 arrangement may configure vacuum sensor 120 to report detectedvacuum and changes in vacuum encountered during the course of thephacoemulsification procedure. Sensed vacuum levels are input ortransmitted to controller or computer 110, representing the vacuum leveldetected on the output side of pump 112.

The present design provides for driving the handpiece tip frominstrument detected vacuum levels during transversal mode operation byvarying the ratio for longitudinal and transversal tip displacements inrelation to changes in detected vacuum. The present design may adjustthe tip displacement control signal to vary the cutting mode tipdisplacement ratio as determined based on measurement of certain systemparameters or values encountered during the operating procedure, such asbased on measured vacuum received from the instrument sensor, whereincutting mode tip displacement ratio may dynamically or automaticallychange between the two different cutting modes. The cutting mode tipdisplacement ratio may be considered as a ‘duty cycle’ representing theamount of interleaving time allocated to each cutting mode, or mayrepresent frequencies or other operational parameters associated withthe multiple modes. In other words, the tip displacement ratio may beoperating in longitudinal mode at one frequency and concurrently intransversal mode at a different frequency.

Duty cycles are generally described above with respect to FIGS. 14A-C.In general, the surgeon may choose a setting from the instrument systemsinput device. Operation may be divided between a first cutting mode anda second cutting mode based on a desired ratio or differential betweenthe modes, such as percentage of operating time, frequency, power, etc.This enables vacuum or some other reading or value to be employed tocontrol power delivery at the handpiece tip for each longitudinal andtransversal cutting tip displacement.

For example, in one embodiment the present design may enable the surgeonto choose an instrument setting at the graphical user interface or otherinput device for increasing the frequency of longitudinal operationrelative to transversal operation as a detected parameter, such asvacuum, changes during the surgical procedure. In this arrangement, theinstrument system may increase or decrease the frequency of longitudinaloperation relative to transversal operation during an ocular procedurein real-time in accordance with reported, sensed, or measured changesin, for this example, vacuum.

Another example varies power level based on sensed vacuum, similar tothe variation of levels illustrated in FIG. 15A. In this example, thedesign may relate vacuum levels to frequency supplied at the handpieceby the instrument system. The sensed, measured, or detected vacuum, i.e.detected amount of vacuum reported from the instrument system, iscorrelated to a percentage of the overall frequency of operationassigned to longitudinal cutting mode A. The present design may cyclebetween two cutting tip movements by shifting the ratio of the frequencyof the control signal directing the handpiece tip for longitudinaloperation and transversal operation. The present design may entailinstrument system 100 to varying the duty cycle for controlling thehandpiece cutting motions while operating in the transversalphacoemulsification mode relative to the longitudinal mode based on thedetected parameter, such as detected vacuum.

In another embodiment, the design may involve employing or interleavingmodes operating at certain frequencies, where one frequency is assignedto control the amount of longitudinal displacement and the secondfrequency is assigned to control the amount of transversal displacement.In this arrangement, the design may vary the amount of each componentrelative to changes in values reported from a sensor, such as a vacuumsensor. For example, the surgeon may set the instrument to increase thefrequency of longitudinal operation as the desired parameter increases,such as while vacuum increases, while concurrently decreasing thefrequency of transversal operation. In this manner, the present designdynamically varies or changes the ratio of longitudinal to transversaltip displacement.

In short, the apparatus and method may provide for real-time control ofthe medical instrument system affording dynamic alterations to the dutycycle or ratio that indicates the amount of time the handpiece tipoperates in the longitudinal cutting mode versus the transversal cuttingmode. During the course of the surgical procedure, the surgeon maychange the duty cycle in response to observed surgical events, such asusing a user interface configured to change parameters and/or ratiosbetween modes. For example, if the surgeon determines the handpiece tipis not effectively boring into the lenticular matter, such as a lensparticle, the surgeon may select a different duty cycle ratio settingfrom the graphical user interface input device favoring a longerlongitudinal duration.

While the present design has been described with particular emphasis onvacuum parameters, vacuum reading, and vacuum sensing, it is to beunderstood that other parameters may be measured and employed to varyratios of operating mode times or frequencies. For example, parametersincluding but not limited to fluid pressure, ultrasonic powerapplication, heat/temperature, or other parameters may be used as thecontrol parameter monitored and employed to vary the operational moderatio. In cases where aspiration flow rate is a measured value ratherthan vacuum, such as in the case of venturi pumps, aspiration oraspiration flow rate may be measured and control provided based onaspiration rate.

Also, while two modes have been described, more than two modes may bevaried if desired, with certain values variable depending on certainconditions. For example, if vacuum sensing is employed and threeoperating modes offered, the surgeon may set the first and secondoperating modes to vary between zero and 100 per cent in the lower halfof the anticipated vacuum range, and between the second and thirdoperating modes between 100 and zero percent in the upper half of theanticipated vacuum range. In this arrangement, thinking of theanticipated vacuum range going from zero per cent (lowest vacuum) to 100per cent (highest vacuum), the lowest vacuum point correlates to 100 percent of mode 1, and zero per cent modes 2 and 3. The 50 per cent point,half anticipated vacuum range, represents 100 per cent mode 2, zero percent modes 1 and 3. The 100 per cent point, highest anticipated vacuumrange, represents zero per cent modes 1 and 2 and 100 per cent point 3.Other implementations may be achieved, in combination with or in placeof switches, foot pedals, or other user interface devices orfunctionality, and may be offered to the user.

Thus the present design comprises a method for controlling anultrasonically driven handpiece employable in an ocular surgicalprocedure. The method comprises operating the ultrasonically drivenhandpiece in a longitudinal motion according to a first set ofoperational parameters, such as time of operation, power of operation,frequency, etc., and altering operation of the ultrasonically drivenhandpiece to employ a non-longitudinal motion according to a second setof operational parameters. Altering comprises measuring aphacoemulsification surgical related parameter, such as vacuum, anddynamically selecting operational parameters based on thephacoemulsification surgical related parameter, and changing operationalparameters for the longitudinal motion relative to operationalparameters for the non-longitudinal motion.

One embodiment of an apparatus as discussed herein is a deviceconfigured for use in an ocular surgical procedure, including ahandpiece having an ultrasonically vibrating tip operational withinoperating modes including a longitudinal operating mode, a sensingdevice, and a controller connected to the handpiece and sensing deviceconfigured to receive data from the sensing device and adjust at leastone longitudinal parameter associated with the longitudinal operatingmode and concurrently adjust at least one parameter associated withanother operating mode according to the data received from the sensingdevice. The controller is further configured to balance between the twomodes according to the data received from the sensing device.

Enhanced Operation

The present design may operate in the presence of non-standard readingsor inputs. While previous embodiments have been described with respectto footpedal movements or other switching and vacuum or other parameterreadings exceeding or meeting certain thresholds, it is to be triggerswitching in the present design, or monitoring of inputs or parametersto determine whether desired performance is achieved may occur. As oneexample of this enhanced performance, the present design may monitorvacuum levels for certain conditions, such as occlusion conditions, andif those conditions are encountered, the system may engage different tipoperation.

FIGS. 16 and 17 depict graphical examples of monitored vacuum levels.FIG. 16 shows an example in which Max Vac (1610) is set at a level aboveocclusion threshold (1608). Low Vac (1606) and Low Threshold (1604) arealso pre-determined or programmed. The monitored vacuum is line 1602.Starting at the left side of FIG. 16 and following monitored vacuum 1602to the right, as vacuum 1602 rises during a procedure and crossesocclusion threshold 1608, the system recognizes that an occlusion hasbegun and a timer begins measuring the time. If vacuum 1602 reaches theMax Vac level (not shown), then the pump may be turned off and themaximum allowable vacuum level may be re-set to Low Vac. If Max Vac isnot exceeded and once the measured time has passed the threshold time(t_(T)), then the maximum allowable vacuum level is dropped to the LowVac level, thereby reducing the monitored vacuum 1602. Alternately, theLow Vac may be set without waiting for a threshold time to pass, inwhich case a timer would not be needed. As the occlusion is cleared bywhatever means, vacuum 1602 begins to drop again until it falls belowLow Threshold (1604). At that point, the system recognizes that theocclusion has been cleared, and Max Vac is re-set as the maximumallowable vacuum level. The monitored vacuum level 1602 typically staysat the lower level in flow pump systems until another occlusion isencountered. When another occlusion is encountered, the vacuum 1602begins to rise again and the process stated above begins anew.

FIG. 17 shows a similar example to that of FIG. 16, with the differencethat the Max Vac value (1710) and the occlusion threshold value (1708)are pre-determined or programmed at or very near the same level. Low Vac(1706) and Low Threshold (1704) are also pre-determined or programmed.The monitored vacuum line on the graph is 1702. Starting at the leftside of FIG. 17 and following monitored vacuum 1702 to the right, asvacuum 1702 rises during a procedure and reaches occlusion threshold1708 and Max Vac level 1710, the system recognizes that an occlusion hasoccurred and a timer begins measuring the time. Additionally, the pumpis typically turned off and the maximum allowable vacuum level is re-setto Low Vac, thereby reducing the monitored vacuum 1702. In someembodiments, the Low Vac is not set until the threshold time has beenreached. Alternately, the Low Vac may be set without waiting for athreshold time to pass, in which case a timer would not be needed. Asthe occlusion is cleared by whatever means, vacuum 1702 begins to dropagain until it falls below Low Threshold (1704). At that point, thesystem recognizes that the occlusion has been cleared, and Max Vac(1710) is re-set as the maximum allowable vacuum level. The monitoredvacuum level 1702 typically stays at the lower level in flow pumpsystems until another occlusion is encountered. When another occlusionis encountered, the vacuum 1702 begins to rise again and the processstated above begins anew.

In the present system, rather than switching modes only when certainthresholds in FIGS. 16 and 17 are crossed, modes may be switched atvarying points, including but not limited to the end of the t_(T)period, the beginning of the period when Low Vac 1706 is reached, thened of the period when Low Vac 1706 occurs, when the Low Threshold 1704is achieved after previous events have occurred, commences, a certainamount of time has passed since an event occurred, or some otheroccurrence has transpired. In this event, either when such occurrenceoccurs or when some other switching trigger occurs, modes may beswitched as discussed herein. As a further example, if a certain vacuumlevel is achieved and a footpedal is at a specific desired orientation,or a specific time after a vacuum pressure has been achieved a switchingdevice such as a footpedal is in a certain state or range, the systemmay switch modes as described herein. Again, the foregoing are simplyexamples, and other criteria for switching may be employed while in thescope of the present invention.

The design presented herein and the specific aspects illustrated aremeant not to be limiting, but may include alternate components whilestill incorporating the teachings and benefits of the invention. Whilethe invention has thus been described in connection with specificembodiments thereof, it will be understood that the invention is capableof further modifications. This application is intended to cover anyvariations, uses or adaptations of the invention following, in general,the principles of the invention, and including such departures from thepresent disclosure as come within known and customary practice withinthe art to which the invention pertains.

In the foregoing specification, the invention has been described withreference to specific embodiments thereof. It will, however, be evidentthat various modifications and changes may be made thereto withoutdeparting from the broader spirit and scope of the invention. Forexample, the reader is to understand that the specific ordering andcombination of process actions described herein is merely illustrative,and the invention may appropriately be performed using different oradditional process actions, or a different combination or ordering ofprocess actions. For example, this invention is particularly suited forapplications involving medical systems, but can be used beyond medicalsystems in general. As a further example, each feature of one embodimentcan be mixed and matched with other features shown in other embodiments.Additionally and obviously, features may be added or subtracted asdesired. Accordingly, the invention is not to be restricted except inlight of the attached claims and their equivalents.

1. A method for controlling an ultrasonically driven handpieceemployable in an ocular surgical procedure, comprising: operating theultrasonically driven handpiece in a first tip displacement modeaccording to a first set of operational parameters; and enabling a userto alter the ultrasonically driven handpiece to employ a second tipdisplacement mode using a second set of operational parameters; whereinsaid enabling comprises the user being enabled to dynamically selectoperational parameters for the first tip displacement mode relative tothe second tip displacement mode.
 2. The method of claim 1, wherein thefirst tip displacement mode comprises longitudinal motion and the secondtip displacement mode comprises non-longitudinal motion.
 3. The methodof claim 2, wherein the first tip displacement mode and second tipdisplacement mode both comprise longitudinal motion.
 4. The method ofclaim 2, wherein the first tip displacement mode and second tipdisplacement mode both comprise non-longitudinal motion.
 5. The methodof claim 1, wherein said user being able to dynamically selectoperational parameters comprises the user being able to engage anenhanced mode of operation to provide certain enhanced operation in atleast one tip displacement mode.
 6. The method of claim 2, wherein saidnon-longitudinal motion comprises a transversal motion.
 7. The method ofclaim 6, wherein said longitudinal motion is interleaved with thetransversal motion.
 8. The method of claim 2, wherein said enablingcomprises providing the user with a footpedal configured to interfacewith the ultrasonically driven handpiece enabling the user todynamically select longitudinal motion parameters relative tonon-longitudinal motion parameters by engaging the footpedal.
 9. Themethod of claim 1, wherein increasing the first set of parameters causesa resultant decrease in the second set of parameters.
 10. The method ofclaim 1, wherein parameters comprise at least one from a group includingpower level, on time, off time, speed, duty cycle, pulse rate, andfrequency.
 11. The method of claim 2, wherein dynamically selecting thefirst set of parameters relative to the second set of parameterscomprises varying the ratio of time allocated to longitudinal cuttingrelative to non-longitudinal cutting.
 12. The method of claim 11,wherein varying the ratio of time comprises increasing time allocated tolongitudinal operation while proportionally decreasing time allocated tonon-longitudinal operation.
 13. The method of claim 11, wherein varyingthe ratio of time comprises a decrease in time allocated to longitudinaloperation while proportionally increasing time allocated tonon-longitudinal operation. 14-22. (canceled)
 23. A method forcontrolling an ultrasonically driven handpiece employable in an ocularsurgical procedure, comprising: operating the ultrasonically drivenhandpiece in a first operating motion according to a first set ofoperational parameters; and enabling a user to alter the ultrasonicallydriven handpiece using a switching apparatus to employ a secondoperating motion using a second set of operational parameters; whereinsaid enabling comprises the user being enabled to dynamically selectoperational parameters for the first operating motion relative to thesecond operating motion via the switching apparatus.
 24. The method ofclaim 23, wherein the first operating motion is a longitudinal motionand the second operating motion is a non-longitudinal motion.
 25. Themethod of claim 23, wherein the first operating motion is generally thesame as the second operating motion.
 26. The method of claim 23, whereinthe first operating motion is a non-longitudinal motion and the secondoperating motion is also non-longitudinal.
 27. The method of claim 24,wherein said non-longitudinal motion comprises a transversal motion. 28.The method of claim 24, wherein said longitudinal motion is interleavedwith the transversal motion.
 29. The method of claim 23, wherein saidswitching apparatus comprises a footpedal enageable by the user andconfigured to interface with the phacoemulsification surgical instrumentenabling the user to dynamically select longitudinal motion parametersrelative to non-longitudinal motion parameters.
 30. The method of claim23, wherein motion parameters comprise at least one from a groupincluding power level, frequency, and vacuum.
 31. The method of claim24, wherein said non-longitudinal motion comprises a torsional motion.